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Decline in teen smoking resumes in 2011

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Related news release: Marijuana use continues to rise among U.S. teens, while alcohol use hits historic lows

ANN ARBOR, Mich.—The 2011 national survey results from the Monitoring the Future study show decreases in teen smoking in all three grades under study—grades 8, 10, and 12. The proportion saying that they smoked at all in the prior 30 days fell significantly for the three grades combined, from 12.8% in 2010 to 11.7% this year.

"This is very good news for the health and longevity of these young people," said Lloyd Johnston, the principal investigator of the study. "Even a reduction of only one percentage point can translate into thousands of premature deaths being prevented." More than 400,000 Americans per year are estimated to die prematurely as a result of their smoking cigarettes; and most smokers begin their habit in adolescence.

Monitoring the Future: a continuing study of American YouthThe good news this year was especially welcome because it followed some evidence in the 2010 survey that the substantial decrease in teen smoking begun in the mid-1990s had decelerated considerably, and may have come to a halt among younger teens.

The Monitoring the Future study, which has been tracking teen smoking in the United States for the past 37 years, found that since last year the proportion of students reporting any cigarette smoking in the prior 30 days has decreased among 8th graders from 7.1% in 2010 to 6.1% in 2011, among 10th graders from 13.6% to 11.8%, and among 12th graders from 19.2% to 18.7%. The decline at 10th grade was statistically significant.

These estimates come from the study's national surveys of some 47,000 students in about 400 secondary schools each year. The study is directed by a team of research professors at the University of Michigan's Institute for Social Research, and since its inception has been funded through a series of research grants from the National Institute on Drug Abuse—one of the National Institutes of Health.

Peak smoking levels among teens were reached in 1996-1997. Since those peak levels, the proportions of students smoking in the month prior to the annual survey has fallen by large proportions: 71%, 61%, and 49% in grades 8, 10, and 12, respectively. In the five or six years immediately following the peak levels, smoking among teens fell sharply. This likely was due to several factors, including the extensive negative attention the industry received as well as sharply rising cigarette prices caused in part by increased state sales taxes on cigarettes. Also, the Master Settlement Agreement with the state attorneys general caused the tobacco companies to raise cigarette prices considerably, and it ended the Joe Camel ad campaign, and funded a large anti-smoking media campaign aimed at youth (conducted by the American Legacy Foundation). In addition, the numbers of public places in which smoking is permitted has been in decline for some years.

After 2002 (or 2003 in the case of the 12th graders) the decline in teen smoking slowed considerably, at the same time that funding was cut back substantially for national and state anti-smoking campaigns and as less public attention was paid to the issue.

The proportion of students seeing a great risk of harm associated with being a smoker had been rising prior to and during the period of declining use, but leveled off in the past several years. However, this year perceived risk associated with smoking rose in all three grades (significantly so in 10th grade). The proportion of teens saying that they disapprove of smoking had leveled recently, as well, but it also increased in all three grades in 2011 (significantly so in 10th grade).

By taking up cigarette smoking, significant proportions of teens are still putting themselves at risk for a host of serious diseases and a premature death. Smoking in the prior 30 days is reported by 6%, 12%, and 19% of 8th, 10th, and 12th graders, respectively. Rates of smoking on a current daily basis are 2.4%, 5.5%, and 10% in the three grades, respectively. Based on follow-up surveys of previous 12th grade classes, quite a number of the lighter smokers are likely to become daily smokers after they leave high school.

One reason smoking has declined so sharply is that the proportion of students who ever try smoking has fallen dramatically. While 49% of 8th graders in 1996 had tried cigarettes, "only" 18% of the 8th graders in 2011 indicate having ever done so, a 63% decline in smoking initiation over the past 15 years.

Eighth and 10th grade students are asked about how difficult it would be for them to get cigarettes, if they wanted them—what the researchers call perceived availability. This measure showed a fairly sharp drop after 1996. The decline in perceived availability halted after 2007, but resumed again this year. The 8th graders have shown the sharpest decline—from 77% saying they could get cigarettes "fairly easily" or "very easily" in 1996 compared to 52% in 2011. Perceived availability among 10th graders fell from 91% in 1996 to 74% by 2011. "Although there has been some real progress made in reducing the availability of cigarettes to those who are underage— particularly to the younger teens—it is clear that the majority of teens still say they can get cigarettes fairly easily," Johnston said.

Attitudes toward smoking and smokers changed in important ways during the period of sharply declining cigarette use. These changes included increases in preferring to date nonsmokers, strongly disliking being around people who are smoking, thinking that becoming a smoker reflects poor judgment, and believing that smoking is a dirty habit. All of these negative attitudes about smoking and smokers rose to high levels by 2007, but they have either leveled or begun to reverse since then (Table 3).

"Future progress in lowering teen smoking rates is likely to depend on there being further changes in the external environment—policy changes such as raising cigarette taxes, further limiting where smoking is permitted, bringing back broad-based anti-smoking ad campaigns, and making quit-smoking programs more available," Johnston said.

Smokeless tobacco

The use of smokeless tobacco (which includes snuff, plug, dipping tobacco, chewing tobacco, and more recently "snus") also is assessed in the study. ("Snus" is a spitless chewing tobacco, pronounced "snoose.") From the mid-1990s to the early 2000s, there was a substantial decline in smokeless tobacco use among teens—monthly prevalence fell by one third to one half—but the declines ended and a rebound in use developed from the mid-2000s through 2010. This rebound did not continue into 2011, however; and there was some decline in all three grades (none statistically significant). Thirty-day prevalence of smokeless tobacco use in 2011 is 3.5%, 6.6%, and 8.3%, among 8th, 10th, and 12th graders, respectively. The rates are considerably higher for boys—4.9%, 11.5%, and 14.2%.

Perceived risk appears to have played an important role in the decline of smokeless tobacco use, as was true for cigarettes. In all three grades, perceived risk for smokeless tobacco rose fairly steadily from 1995 through 2004 before leveling. However, there has not been a great deal of fall-off in these measures since 2004, suggesting that other factors may be leading to the recent increases in use—possibly increased promotion of these products and a proliferation of types of smokeless tobacco products available.

Hookahs and small cigars

Two of the latest developments to raise public health concern are the smoking of tobacco by using hookah (pronounced "WHO-ka") water pipes, and the smoking of small cigars. Questions about these forms of tobacco use were included in the survey of 12th graders for the first time in 2010. In 2011 the annual prevalence rate for smoking with a hookah rose by 1.4 percentage points to 18.5%—not a statistically significant increase. Only 10% of 12th grade students reported smoking with a hookah more than two times during the year, suggesting a considerable amount of light or experimental use. Males had only a slightly higher prevalence rate than females—20% versus 17%.

Smoking small cigars is a more prevalent behavior, with 12th graders having an annual prevalence in 2010 of 23%, but with only 11% indicating use on more than two occasions during the year. There is a larger gender difference for this form of tobacco use, with an annual prevalence of 27% among males compared to 12% among females.

"We will continue to monitor these two forms of tobacco consumption to see if they represent a growing problem among youth, and we will be examining their use among young adults, as well," Johnston said.

 

Monitoring the Future has been funded under a series of competing, investigator-initiated research grants from the National Institute on Drug Abuse, one of the National Institutes of Health. The lead investigators, in addition to Lloyd Johnston, are Patrick O'Malley, Jerald Bachman, and John Schulenberg—all research professors at the University of Michigan's Institute for Social Research. Surveys of nationally representative samples of American high school seniors were begun in 1975, making the class of 2011 the 37th such class surveyed. Surveys of 8th and 10th graders were added to the design in 1991, making the 2011 nationally representative samples the 21st such classes surveyed. The 2011 samples total 46,733 students located in 400 secondary schools. The samples are drawn separately at each grade level to be representative of students in that grade in public and private secondary schools across the coterminous United States. Schools are selected with probability proportionate to their estimated class size.

The findings summarized here will be published in a forthcoming volume: Johnston, L. D., O'Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2012). Monitoring the Future national results on adolescent drug use: Overview of key findings, 2011. Ann Arbor, MI: Institute for Social Research, University of Michigan.

The content presented here is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Drug Abuse, or the National Institutes of Health.


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